Dr. Murai Éva szerk.: Parasitologia Hungarica 24. (Budapest, 1991)

Table 3 Relapsing facial palsy in Lyme borreliosis Facial palsy Etiology single relapsing sum non-Lyme 443 45 (9.2%) 488 Lyme 159 7 (4.2%) [0%]* 166 Sum 602 42 654 p<0.05 * Multiple or single relapse after six months tein level was even more typical of the Bannwarth's syndrome patients (Fig. 4). CSF sugar levels were usually found to be normal (average 2.98 mM/L, SD:0.89) however, low sugar levels were measured in significantly more cases of Lyme meningitis than in other diseases with CNS involvement (Fig. 5). The difference was striking in BS (p=

0.0005). Four cases of typical BS were originally treated with antituberculotic drugs because of the chronic lymphocytic pleocytosis, high protein and low sugar levels in the CSF. Culture for mycobacteria was negative in all four cases. Facial palsy. Shortly after Bb antibody testing was started, the high frequency of peripheral facial paresis among Lb patients became obvious (76). Facial palsy was often associated with meningitis (Table 1) or, in many cases, it was just one symptom forming part of Bannwarth's syndrome. There were also many occasions when it presented by itself, thus fulfilling the diagnostic criteria for Bell's palsy. Bilateral presentation was more frequently found among Lb patients (Table 2). Of the seronegative patients with diplegia, six suffered from Guillain-Barré syndrome. The relapsing facial palsy often proved to be seronegative (Table 3). In the relapsing case of facial palsy caused by borrelia the second attack was seen within 6 months, while the symptom-free intervals were longer (usually several years) in the seronegative patients. In the idiopathic group multiple relapses were regularly seen, but never among Lb patients. In a previous study, thirty well-documented and untreated Bell's palsy cases were analysed. We found that Bell's palsy caused by Bb has a better outcome in spite of the initially more serious paresis (102). Central nervous system involvement. Patients with CSF pleocytosis but not fulfilling the criteria of BS were included into this group. In many cases, lymphocytic meningitis was found, clinically indistinguishable from those of viral origin. However, in cases of borrelia meningitis there was a strong tendency for longer recovery and more serious fatigue as compared to viral meningitis. More pronounced differences could be observed in the encephalitis. In Lb, symptoms started less dramatically and coma seldom developed. Convulsion appeared in three cases only. Serious fatigue and memory disturbances developed in almost every long-standing